Presentation on theme: "A Review of Mental Health Acute Admissions"— Presentation transcript:
1A Review of Mental Health Acute Admissions Dr R Belgamwar, Mrs L Wrench, Mrs R Purkayastha, Dr R Johnston and Dr J Christie - GP Trainees, Dr M Abdelrahman -F1 Trainee1. National Service Framework for Mental Health: Department of Health, September 1999.
2‘Acute inpatient care is a core and integral component of the National Service Framework for mental Health to which all the NSF standards are relevant…reshaping the organisation of inpatient services to provide a more effective, safe and therapeutic inpatient experience built around the needs of the service users, their families and carers is a NSF priority’ 1
3BackgroundAccording to the Mental Health Policy Implementation Guide, it has been reported by service users that admission to acute inpatient care is in itself distressing and demeaning, therefore it is paramount that assessment, care delivery and discharge planning should be wholly focused around the service user.
4Locally major changes have taken place e.g. The abolition of inpatient services in two mental health resource centresReconfiguration and reduction of beds within Harplands HospitalThe changes to single sex ward environment.Increase in the multidisciplinary therapy and activities provisionRole of crisis/HT team in gate keeping admissionsProviding named care-coordinator7 day follow up in the communityThe ward changes have occurred via a phased approach starting from October 2005
5AimTo evaluate the new service model with a view to improving Acute Adult Mental Health Care.ObjectivesTo compare NSCHT adult mental health inpatient statistics against national performance indicators and statistics.To ascertain the current level of service provided to adult mental health inpatients.
6Method Part 1Electronic Reporting Comparison of Before and After Ward RestructuringThe following samples were identified by the North Staffordshire Health Intelligence Service (HIS) using the Combined Healthcare Hospital Information Processing System.All patients discharged from Harplands wards and resource centres between1st January 05 to 30th June 051st December 06 to 31st May 071st September 2007 and 29th February 2008Data included:General demographic detailsLength of stay (episode)Number of occupied bed daysAdmission rateType of patient (formal / informal)Referral sourceDischarge diagnosisReadmissions within 28 daysNo of incidents for the period
7Method Part 2 Review of Acute Admissions and Assessments All patients discharged from the following locations between 1st September 2007 and 29th February 2008 (inclusive)Harplands Wards 1,2 and 3County Resource Centres (Ashcombe and Lymebrook)City Resource Centres (Sutherland and Bennett)A random sample of 50 patients was selected from the Harplands Wards (1, 2 and 3) and another 50 patients were selected from the Resource Centres.Casenotes of a final sample of 86 patients were reviewed from admission to discharge.
8In the last 30 years…..The key aim of mental health care has been to support people to live independent lives through better care and treatment in the communityE.g.In-patient psychiatric beds has fallen dramatically – 87,396 beds in 1980 to 29,802 beds inRise in the community services – Includes CMH Teams, assertive outreach teams, crisis teams, community rehabilitation teams, home treatment teams etc.
9How many inpatient beds? Depends on several factors including deprivation, other community and support services such as crisis/HT, community houses, day centres/hospitals etc, local drivers and financial provisions.Gate keeping procedures and facilitation early dischargeAny report giving an estimates become quickly outdated in view of rapidly changing scenario.Inpatient beds are most expensive component of mental health servicesGrowing Independent and private sector inpatient provisionSome reports of increased number of mentally ill people in prison and ?Inversely proportional to the available psychiatric beds.
10Nick Nalladori, a carerIn 2005/2006, more than two-thirds of the NHS budget for clinical mental health services in England was spent on in-patient psychiatric hospital care.However, in England, there are fewer in-patient beds now than at any other time.The Mental Health Act Commission found that between 2005 and 2007, 37% of all wards they visited were running at over 100% bed occupancy.Crisis resolution teams are intended to reduce the need for hospitalisation. However, as yet, they do not have sufficient staff to meet this aim.High bed occupancy does not arise only because the numbers of in-patient beds has been reduced but also because of ‘bed blocking’.ReferencesThe Mental Health Act Commission (2008) Risk, Rights and Recovery. Twelfth Biennial Report 2005–2007. TSO (The Stationery Office).National Audit Office (2007) Helping People Through Mental Health Crisis: The Role of Crisis Resolution and Home Treatment Services. TSO (The Stationery Office).
11Local factors Deprivation above average High unemployment High mortality rate – Sentinel report dt: 01/12/2009-Stoke 204, North Staffs 170, South Staffs 171, Central Cheshire 161 (Per 100,000)
16Bed Availability Data source Population reference - Mid 2006 Estimate:England: (100,000)CHC: (100,000)(North Staffs Stoke 24.76)
17Where are 181 beds? In 2005-06 we had Total 181 General Adult 109 beds Rehabilitation35 bedsNeuropsychiatry25 bedsAddiction12 bedsTotal181
18Changing adult inpatient bed availability Specialitycurrent1General Adult109962Rehabilitation35283Neuropsychiatry254Addiction1210Total181(39.45/100000)159 (34.66/100000)England population 5076 (10 000); North Staffs population: = (1000): Both Mid 2006 estimatesKh03 Adult – ward classification included as17 Mental illness: other ages: secure unit; 18 Mental illness: other ages: short stay and; 19 Mental illness: other ages: long stay1. KH03 returns for 2009 will show 167 available beds (36.4/100000). For EMU we reported 14 beds instead of 10 and for Harplands ward 1( including PICU) we reported 24 beds instead of 20.So we have reported 8 extra beds.2. KH03 England 2008 data for adult inpatient beds shows 17,411 available beds (34.3/100000)
19ConclusionsIn England, the number of available beds are reducing year on year, the trend is likely to continue particularly when significant financial cuts are expected.Over last 5 years, CHC Trust have reduced more beds compared to the average England beds for adult mental Illness.Our area has high rates of mortality, morbidity, deprivation and low life expectancy.In last 5 years, average bed occupancy rate has not significantly altered even with bed reductions.Locally, a third of our adult beds are for rehabilitation and neuropsychiatry services. This is probably much higher to the national average. These beds can be an income source for our Trust if there is an out of area commissioning/interest.
27Readmissions within 28 days of discharge from previous admission Period1Period 2Period 3Readmissions - count604846Readmissions - patients503437Patient Analysis:1 x readmissions4128332 x readmissions823 x readmissions14 x readmissions6 x readmissionsTotal
29Conclusion – Part 1The restructuring in provision of adult mental health care has resulted in a number of positive outcomes. There has been a clear reduction in number of patient admissions across all service areas. The length of stay of admitted patients has also reduced and once discharged, the patients have less frequently been readmitted. Clinical outcome measure are not recorded.The introduction of the Home Treatment and Crisis Teams have enabled some patients who may have previously been managed as inpatients, be successfully managed in the community, and have supported inpatients on discharge to prevent relapse and deterioration and subsequent readmission.
30Conclusion – Part 1Patient demographics didn’t change much. They are all of similar age, gender and ethnicity as compared to before service reform.The proportion of admissions from each PCT is also comparable, as is the admission source.There is a small variability in primary diagnosis at discharge however, with schizophrenia and delusional disorder being more commonly reported after service reform and mood disorder less so.The changes shows improved use of resources, accommodating bed reductions and bed availability for the more acutely unwell patient have benefits to the patients and clear financial benefits.The success of the ward restructuring at the Harplands is also suggested by the reduced number of reported incidents across. However more incidents were reported in the community inpatient setting early transfer from Harplands.
31Acknowledgements for Part 1 Data analysis has been provided with kind support from L J McDermott and L Warrilow, North Staffordshire Combined HealthcareReferencesInformation for Health. Department of Health, 1998.Key Statistics Summary DataHSE online
32Type of admission and Average Length of Stay (n=86) Harplands 44 daysCounty daysCity 63 days
34Observation level on admission and Detentions Number (%)Harplands(n=46)County(n=22)City(n=16)General28(61%)21(95%)15(94%)Constant visual3(6%)-Close intermittent15(33%)1(5%)1(6%)29% service users were detained at some point during their admission – most on sections 2 and 3
35CPA level on discharge (n=86) Number (%)Harplands(n=41)County(n=26)City(n=19)Standard11(27%)10(39%)4(21%)Enhanced27(66%)16(61%)14(74%)Not registered at time of discharge3(7%)-1(5%)Most common Care Coordinator was the CPN66/83 (80%) service users had a discharge planning meeting prior to dischargeIn 39/50 (78%) cases the CC was present at the meeting
36Discharge Letter sent to (n=61) Discharge Letter (n=86)In 61/86 (71%) cases there was a discharge letter present in the notesIn 27/61 (44%) cases the name of the care co-ordinator was present in the letterIn 19/61 (31%) cases the contact details of the care co-ordinator was present in the letterDischarge Letter sent to (n=61)Average length of time between date of discharge and date letter sent was 7 days
37The pathway to recovery A review of NHS Acute Inpatient ServicesProvides benchmarkingReport published in 2008 with the aim toSupport people to live independently in the communityStrengthening community servicesImprovement in the quality of serviceEmphasis on high quality care and pathways to achieve best possible outcome
38Health Care Commission Assessment Criteria 1. Effective care pathwayTo insure appropriate admission and discharge is timelyProviding appropriate and safe interventionsWorkforce developmentMonitoring and evaluating service e.g. outcome measures2. Individualised whole person careFocus on personalised carePromotes recovery and inclusion3. Involvement of service users and caresUsers and cares involvement in strategic planning, operational, evaluation and development4. SafetyThe safety of service users, staff and visitors